MEDICARE: DR. IDALMIS TERAN-GONZALEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0050123	FL

General Provider Information

NPI Number	:	1679518302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IDALMIS TERAN-GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 400
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2051
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 S CONGRESS AVE
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-5903
Country	:	US
Telephone Number	:	561-966-1000
Fax Number	:	561-432-0618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	12/06/2021

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